Grant Wilson Gonzalez, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016005651 Issued in IL

Practice address

2921 Montvale Dr
Springfield, IL 62704-5359

Phone

(217) 787-2700

Fax

(217) 787-2715

NPI assigned

Aug 31, 2013

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foot and Ankle Center of Illinois PCGroup PAC ID 9638347586, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Hospital Hospital, Decatur, IL, CCN 140166
• Carlinville Area Hospital Hospital, Carlinville, IL, CCN 141347
• Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135
• St Johns Hospital Hospital, Springfield, IL, CCN 140053
• HSHS Good Shepherd Hospital Inc Hospital, Shelbyville, IL, CCN 141354

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Foot & Ankle Center of Illinois PC

  • Primary Podiatric Medicine Podiatrist
  • Springfield, IL
  • NPI 1598058547
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carlinville Area Hospital Association

  dba Carlinville Area Hospital

  • Critical Access Hospital
  • Carlinville, IL
  • NPI 1053425124
  Care Compare affiliation
• Decatur Memorial Hospital

  • General Acute Care Hospital
  • Decatur, IL
  • NPI 1548357973
  Care Compare affiliation
• HSHS Good Shepherd Hospital Inc

  • Critical Access Hospital
  • Shelbyville, IL
  • NPI 1053348532
  Care Compare affiliation
• St Johns Hospital of the Hospital Sisters of the Third Order of St F

  dba HSHS St. John's Hospital

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1205818481
  Care Compare affiliation
• St Marys Hospital Decatur of the Hospital Sisters of the Third Order

  dba St Marys Hospital

  • General Acute Care Hospital
  • Decatur, IL
  • NPI 1326041229
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1164856704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 MONTVALE DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627045359",
            "telephone_number": "217-787-2700",
            "fax_number": "217-787-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 MONTVALE DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627045359",
            "telephone_number": "217-787-2700",
            "fax_number": "217-787-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "GRANT",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-31",
        "last_updated": "2023-03-07",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001231",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS",
            "identifier": "016005651",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Michael Golitko, DO
• Tabatha Marie Golman
• Gerardo Francisco Gomez Abundis, M.D.
• Erika Alejandra Gonzalez Osorio, MD
• Susana Gonzalez-Martinez
• Jose A Gonzalez, MD
• Lenore Evans Gonzalez, M.D.
• Kayelene Paige Goodbear, COTA/L
• Michaela Rose Goode, MA, BCBA
• Natalie Goodwin

• Foot & Ankle Surgery Podiatrist in Springfield, IL
• Providers in Springfield, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.